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Publication of consultant treatment outcomes

NHS England has begun the staged publication of mortality rates
for individual hospital consultants in ten specialities, a major
breakthrough in NHS transparency.

This leads a push to give patients more information about their
treatment, helping the NHS drive up and maintain the quality of
care.

The data - covering around 3,500 consultants - can be seen on
the NHS Choices website. (Click here www.nhs.uk/consultantdata).

The data will initially be refreshed annually and publishing of
data in this way will be mandatory from next year.

County Durham and Darlington NHS Foundation Trust

County Durham and Darlington NHS Foundation Trust regards the
publication of consultant treatment outcomes as vital to help
improve patient care and drive up standards. It is an opportunity
for patients to ask about a consultant's performance, via their GP
or the consultant directly. We are committed to being transparent
in how we work and look after patients, and patients should feel
encouraged and at liberty to ask or challenge members of our
staff.

The Trust has recently established a Mortality Review committee
in order to review mortality rates, the overarching aim of which is
to ensure that there are no preventable deaths occurring across the
organisation.

How can I use the data?

The information published so far includes how many times each
participating consultant has performed certain procedures and what
their mortality rate is for those procedures. You can see whether
or not the data for each consultant is within or outside the
expected range. Consultants who fall outside the expected range are
sometimes referred to as 'outliers'.

You can use this data to decide which consultant to choose for
your care. However, there are some important issues to bear in mind
when looking at the data.

For instance, the vast majority of the data has been through a
process known as 'risk adjustment'. This is a way of accounting for
the different mix of patients operated on by a particular
consultant's team. Using risk adjustment, outcomes are calculated
as if all consultants operated on the 'average' patient. This means
that consultants who take on particularly poorly, high-risk
patients or carry out the most complicated procedures don't appear
to have an unfairly high mortality rate.

However, not all the data can be 'averaged out' in this way.
Specific reasons for this are outlined in the introductory text for
each set of results. Where risk-adjusted data is not available,
actual (also called 'crude') clinical outcomes are shown. If the
data is not risk-adjusted, a consultant may have a higher mortality
rate simply because he or she takes on more difficult cases.

If you have questions or concerns having viewed specific
results, please discuss these with your GP or consultant.

What will the NHS do where consultants have high mortality
rates?

Any hospital or consultant identified as an outlier will be
investigated and action taken to improve data quality and/or
patient care.

When will data be available for other procedures and
specialties?

The results published to date were selected because relevant
data was already being collected for these procedures and
specialties. It is likely the programme will be extended from 2014
when data for other conditions can be collected and analysed in a
similar way.

Where does the data come from?

The data comes from national clinical audits which continuously
review medical practice to check that it is safe and seek ways to
improve it. These audits are managed by 'audit providers' (usually
academic institutions such as a university or royal college) which
work with the specialist association. A specialist association is
an independent, membership organisation, which represents a
particular medical specialty.

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